Table 3.

Summary of case histories and circumstances of deaths

Pt no./sex/ age at surgery, ySide/ pathology at operationSeizure status postoperativelyPostop survivalDetails of deathDeath certificateClassification
MTS = mesial temporal sclerosis; GTCS = generalized tonic-clonic seizures; SUDEP = sudden unexplained death in epilepsy; AED = antiepileptic drug; DIC = disseminated intravascular coagulation; DNT = dysembryoplastic neuroepithelial tumor; NS = nonspecific; CPS = complex partial seizures; VNS = vagal nerve stimulator; IC = intracerebral; DVT = deep venous thrombosis.
1/M/17R /MTSSeizure free2 yPostop behavioral disorder: episodic impetuousness & lack of control; ran onto road and killed by passing carRoad traffic accident, multiple traumaAccident, probably epilepsy related
2/M/24R /MTS95% reduction but GTCs8 moFound dead in full bath, bruising to head; autopsy: froth in trachea & lungsDrowning, epilepsy related
3/F/25R /MTS95% reduction but episodes of GTCS3 yStatus epilepticus, died in hospital from cardiorespiratory arrestStatus epilepticusStatus epilepticus
4/F/25R /MTSSeizure free but postop depression6 ySuicide (paracetamol)Renal failure, myocardial infarction, epilepsySuicide, epilepsy related
5/M/23R /MTSSeizure free5 yFound dead at home, brought to hospital, no autopsyStatus epilepticusProbable SUDEP
6/M/29R /MTS75% reduction4 yFound dead at home, autopsy performed but report not availableStatus epilepticusSUDEP
7/F/29R /MTS50% reduction but more “severe” seizures3 yFound dead in bed, AED levels therapeutic; autopsy: mild pulmonary edemaStatus epilepticusSUDEP
8/F/20R /MTS90% reduction, nocturnal GTCS9 yFound dead in bed; autopsy: vomitus in trachea, pulmonary edemaAsphyxiation, epileptic seizureAspiration of vomitus secondary to seizure
9/F/20R /MTSNo change7 yStatus epilepticus, cause uncertain, terminal DICStatus epilepticusStatus epilepticus
10/M/26R /MTSSeizure free5 ySudden death at home while digging in garden, had reduced carbamazepine shortly before death; autopsy: mild pulmonary edema, carbamazepine levels subtherapeutic at 3.0 mmol/L, (range, 4–12 mmol/L)Epileptic seizureSUDEP
11/F/48L /MTS75% reduction but GTCS6 yFound dead at home; autopsy: mild pulmonary edemaStatus epilepticusSUDEP
12/F/26L /MTSSeizure free for 4 years then infrequent GTCS, 1 every 3 mo8 yDrowned in bath, 5 weeks pregnant; postmortem carbamazepine levels 2.2 mmol/L, (range, 4–12 mmol/L)Pulmonary edema, epilepsyDrowning, epilepsy related
13/F/36L /MTSSeizure free12 yMetastatic breast carcinomaAdenocarcinoma of breastCancer
14/F/22L /DNTSeizure free5 yDrug & alcohol addiction; died in police van after arrest for drunkenness, uncertain whether seizure occurredAlcohol intoxication, asphyxiationAsphyxiation, possibly epilepsy related
15/M/20L /DNTSeizure free8 yAlcohol intoxication, slipped on river bank while urinating, drownedDrowning, accidental deathDrowning, not epilepsy related
16/M/22L /NSSeizure free for 2 years, then relapsed with CPS & GTCS6 yFound dead in bed; autopsy: mild pulmonary edema; VNS inserted 1 month before deathEpileptic seizureSUDEP
17/M/39R /NSReduction in seizure severity15 yMyocardial infarctionMyocardial infarctionIschemic heart disease
18/F/44L /NSIC hemorrhage 12 days postop, related to heparin treatment for DVTCerebral hemorrhageOperative complication
19/F/51L /NSPostop cerebral edemaCerebral edema, craniotomyOperative complication
20/F/29L /NSNo change2 yAspiration pneumonia in nursing home, had dense postop R hemiplegiaAspiration pneumonia, epilepsyOperative complication